Provider Demographics
NPI:1245251370
Name:SMITH-GUMBS, KIM L (OT)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:L
Last Name:SMITH-GUMBS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6741 CORAL WAY
Mailing Address - Street 2:22
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1762
Mailing Address - Country:US
Mailing Address - Phone:305-262-4422
Mailing Address - Fax:
Practice Address - Street 1:6741 CORAL WAY
Practice Address - Street 2:22
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1762
Practice Address - Country:US
Practice Address - Phone:305-262-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT10597225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8406AMedicare ID - Type UnspecifiedFLORIDA MEDICARE